Restating the burden and cost of dengue

Alvin Manalansan, Health Fellow of the Stratbase ADR Institute

Two weeks ago, the Secretary of the Department of Health Francisco Duque declared a National Dengue Alert. The health department issued this protocol to arrest the continuous upsurge in dengue cases all over the country and prevent an epidemic.

Since the beginning of 2019, more than 115,000 cases were reported with 491 deaths. The scale of the epidemic is nationwide and among those regions that exceeded the threshold were MIMAROPA, Western Visayas, Central Visayas and Northern Mindanao. Moreover, other regions are currently being monitored since they have already exceeded the alert threshold.

As a priority directive from the DOH, regional offices were tasked to step up and prepare their surveillance system, case management protocols and outbreak response. The National Disaster Risk Reduction Management Council also issued a “Code Blue” alert, designating fifty percent of the available health resources, including positioning of front-line teams, to augment the existing services in the treatment of patients in affected areas. Also enjoined are the commitment of public hospitals and health centers in the local government units to prepare the needed medicines, equipment and personnel and respond to identified cases.

Since 2007, dengue surveillance in the Philippines depended mostly on disease reporting units in terms of reporting all suspected, probable, and confirmed dengue episodes to the Philippines Integrated Disease Surveillance and Response System. In fact, about 93% of all dengue episodes reported in 2010–2014 were hospitalized patients and half of these were reported from private facilities. Thus, given the increase in cases and alert declarations, the challenge now for the DOH is to capture and arrest the real situation for dengue in the country.

Previous studies have shown an association between youth and the severity of the dengue infection, with those between five and nine years as the most affected in terms of casualties.

The burden and cost of having a family member infected with dengue eventually affects the productivity of households. The cost-of-illness related to dengue infection is detrimental to a family’s financial situation.

On one hand, the “direct cost” includes (1) “direct medical costs,” which cover consultation, medication, and laboratory test; and (2) “direct non-medical costs,” which cover the expenses related to transportation, food, and lodgings incurred by a patient when seeking treatment, as well as by individuals accompanying a particular patient.

On the other hand, three components comprise the “indirect cost,” namely, (1) patient’s wage loss due to illness; (2) substitute labor cost; and (3) caretaker’s cost. The “wage loss” refers to the amount a patient normally earns for a day’s work and multiplied by the number of days’ loss due to illness. For students, the loss in monetary value can be estimated through the number of the student-loss days multiplied by the government expenditure for a given level of education per student.

In other instances, some patients need to hire “substitute labor” in order to carry out their work as patients are unable to perform their usual activities due to illness. For patients who need to have a “caregiver” while they convalesce during the illness period, these are usually family members who do not get paid for taking care of their love ones and may need to cut back and sacrifice their usual day-to-day activities.

Other than the monetary value, the impact of dengue can also be measured through a public health metrics, such as disability-adjusted life-years (DALYs), which is the sum of a measure equivalent to the years of life lost due to disability and a measure of the years lost due to premature death.

Based on surveillance data in the Philippines for 2010–2014 (Undurraga et.al., 2017), the estimated annual dengue episodes were 794,255 and a disease burden of 535 DALYs per million population using age weights and time discounting; and 997 DALYs per million population without age and time adjustments. Due to the increase incidence this year, there is a great possibility that the annual disease burden of dengue might actually be higher as compared to these estimates.

Despite of the current situation, the DOH, together with the other involved agencies, are indeed commendable for their swift actions. The timely declaration of national alerts demonstrates the preparedness of the concerned offices to implement the emergency-response plans and incorporate them in the usual public health programs. However, it should be reiterated that their roles do not stop there as the public needs their constant support in order to lessen, if not permanently eradicate, the vector-borne disease.

On a final note, the DOH is currently undertaking nationwide public information and health education campaigns to encourage clean-up drives in communities and schools to assure the early detection of the breeding sites and avert the propagation of mosquitoes. Again, rather than merely responding to outbreaks which are considerably costly on the part of the government, the most effective way in dealing with the dengue disease rests in the participation of the public in its prevention and control.